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Doxycycline for Post-Exposure Prophylaxis (DoxyPEP)

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DoxyPEP: A New Sexually Transmitted Disease (STD) Prevention Tool for Providers

CDC Releases DoxyPEP Guidelines

On June 6, 2024, the Centers for Disease Control and Prevention (CDC) published the CDC Clinical Guidelines on the Use of Doxycycline Post-Exposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention. 

The CDC endorses DoxyPEP as the first new STD prevention tool in decades. DoxyPEP is the self-administration of 200 mg of doxycycline within 72 hours after sex to prevent bacterial STD acquisition.  

DoxyPEP has proven to reduce the risk of getting a bacterial STD for syphilis, chlamydia and gonorrhea.
 

DoxyPEP Efficacy and Considerations

The clinical guidelines incorporate the findings of several recent studies demonstrating that oral doxycycline after exposure can reduce the risk of contracting bacterial STDs, such as syphilis, gonorrhea, and chlamydia. DoxyPEP has shown to reduce syphilis and chlamydia by up to 70 percent and gonorrhea by up to 50 percent.

The guidelines also looked at the potential for antimicrobial resistance using DoxyPEP. Doxycycline has been safely used for decades and administered daily to treat conditions such as malaria, acne, and rosacea. Some studies noted some increased resistance to S. aureus. More research is needed to learn about possible significant effects on antimicrobial resistance and the body’s microbiome.
 

Doxy PEP Discussion with Clients

The CDC recommends healthcare providers discuss DoxyPEP with their clients and use their clinical judgment and shared decision-making when discussing DoxyPEP.
 

DoxyPEP Prescribing Guidance

Prescribe DoxyPEP in the context of a comprehensive sexual health exam. Sexual health care should include the following:

  • Risk reduction counseling,
  • STD screening and treatment every three to six months,
  • Recommended vaccinations, and
  • HIV testing with pre-exposure prophylaxis (PrEP) or care services, as appropriate.
  • Inform clients to seek care if they have STD symptoms or exposure.

Common side effects include:

  • Nausea,
  • Vomiting,
  • Diarrhea,
  • Heartburn,
  • Sun sensitivity, and
  • Rarely, esophageal irritation.

Explain to the client drug interactions (magnesium, calcium) and food interactions (dairy). Educate the client on other precautions and how to minimize side effects and interactions, such as:

  • Drink with a full glass of water,
  • Remain upright for 30 minutes after taking DoxyPEP,
  • Avoid taking magnesium or calcium supplements or dairy for two hours before or after DoxyPEP, and
  • Wear sunscreen.

Healthcare providers should prescribe self-administration of 200 mg of doxycycline (any formulation) as soon as possible after sex (ideally within 24 hours but up to 72 hours). DoxyPEP should not exceed a maximum dosage of 200 mg every 24 hours. Providers can prescribe up to a 90-day supply, with refills until the next follow-up visit.
 

Clinical Resources

Some of these resources were created before the publication of the CDC guidelines. Providers should tailor all clinical protocols and educational materials to fit the needs of their local communities while considering the most current CDC guidelines.

CDC

Denver STD Prevention Training Center DoxyPEP Services

National Coalition of STD Directors-DoxyPEP Command Center

San Francisco Department of Health

Seattle & King County Health Department

NYC Department of Health & NY State AIDS Institute

Podcasts and Webinar Recordings